Top

European Journal of Medical Research

Published in:

Open Access 01-12-2024 | Central Nervous System Trauma | Research

The effect of dexmedetomidine on the postoperative recovery of patients with severe traumatic brain injury undergoing craniotomy treatment: a retrospective study

Authors: Zhu Deng, Yong Gu, Le Luo, Lin Deng, Yingwei Li, Wanyong Huang

Published in: European Journal of Medical Research | Issue 1/2024

Abstract

Background

Traumatic brain injury (TBI) has been a worldwide problem for neurosurgeons. Patients with severe TBI may undergo craniotomy. These patients often require sedation after craniotomy. Dexmedetomidine (DEX) has been used in patients receiving anesthesia and in intensive care units. Not much is known about the postoperative effect of DEX in patients with severe TBIs undergoing craniotomy. The purpose of this study was to explore the effects of postoperative DEX administration on severe TBI patients who underwent craniotomy.

Methods

Patients who underwent craniectomy for severe TBI at our hospital between January 2019 and February 2022 were included in this study. The patients were admitted to the intensive care unit (ICU) after surgery to receive sedative medication. The patients were then divided into DEX and control groups. We analyzed the sedation, hemodynamics, and other conditions of the patients (hypoxemia, duration of ventilation during endotracheal intubation, whether tracheotomy was performed, and the duration in the ICU) during their ICU stay. Other conditions, such as delirium after the patients were transferred to the general ward, were also analyzed.

Results

A total of 122 patients were included in this study. Among them, 53 patients received DEX, and the remaining 69 did not. The incidence of delirium in the general ward in the DEX group was significantly lower than that in the control group (P < 0.05). The incidence of bradycardia in the control group was significantly lower than that in the DEX group (P < 0.05). Other data from the DEX group and the control group (hypotension, hypoxemia, etc.) were not significantly different (P > 0.05).

Conclusion

The use of DEX in the ICU can effectively reduce the incidence of delirium in patients who return to the general ward after craniotomy. DEX had no adverse effect on the prognosis of patients other than causing bradycardia.

Godoy DA, Rabinstein AA. How to manage traumatic brain injury without invasive monitoring? Curr Opin Crit Care. 2022;28(2):111–22. https://doi.org/10.1097/mcc.0000000000000914.CrossRefPubMed

Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic brain injury: an overview of epidemiology, pathophysiology, and medical management. Med Clin North Am. 2020;104(2):213–38. https://doi.org/10.1016/j.mcna.2019.11.001.CrossRefPubMed

Khellaf A, Khan DZ, Helmy A. Recent advances in traumatic brain injury. J Neurol. 2019;266(11):2878–89. https://doi.org/10.1007/s00415-019-09541-4.CrossRefPubMedPubMedCentral

Stocchetti N, Carbonara M, Citerio G, Ercole A, Skrifvars MB, Smielewski P, et al. Severe traumatic brain injury: targeted management in the intensive care unit. Lancet Neurol. 2017;16(6):452–64. https://doi.org/10.1016/s1474-4422(17)30118-7.CrossRefPubMed

Wang KK, Yang Z, Zhu T, Shi Y, Rubenstein R, Tyndall JA, et al. An update on diagnostic and prognostic biomarkers for traumatic brain injury. Expert Rev Mol Diagn. 2018;18(2):165–80. https://doi.org/10.1080/14737159.2018.1428089.CrossRefPubMedPubMedCentral

Najem D, Rennie K, Ribecco-Lutkiewicz M, Ly D, Haukenfrers J, Liu Q, et al. Traumatic brain injury: classification, models, and markers. Biochem Cell Biol. 2018;96(4):391–406. https://doi.org/10.1139/bcb-2016-0160.CrossRefPubMed

Ladak AA, Enam SA, Ibrahim MT. A review of the molecular mechanisms of traumatic brain injury. World Neurosurg. 2019;131:126–32. https://doi.org/10.1016/j.wneu.2019.07.039.CrossRefPubMed

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet (London, England). 1974;2(7872):81–4. https://doi.org/10.1016/s0140-6736(74)91639-0.CrossRefPubMed

Shi H, Wang HL, Pu HJ, Shi YJ, Zhang J, Zhang WT, et al. Ethyl pyruvate protects against blood-brain barrier damage and improves long-term neurological outcomes in a rat model of traumatic brain injury. CNS Neurosci Ther. 2015;21(4):374–84. https://doi.org/10.1111/cns.12366.CrossRefPubMed

10.

Wang C, Chang YX, Chen X, Bai L, Wang H, Pan YC, et al. A calixarene assembly strategy of combined anti-neuroinflammation and drug delivery functions for traumatic brain injury Therapy. Molecules. 2022. https://doi.org/10.3390/molecules27092967.CrossRefPubMedPubMedCentral

11.

Keating GM. Dexmedetomidine: a review of its use for sedation in the intensive care setting. Drugs. 2015;75(10):1119–30. https://doi.org/10.1007/s40265-015-0419-5.CrossRefPubMed

12.

Wang D, Xu X, Wu YG, Lyu L, Zhou ZW, Zhang JN. Dexmedetomidine attenuates traumatic brain injury: action pathway and mechanisms. Neural Regen Res. 2018;13(5):819–26. https://doi.org/10.4103/1673-5374.232529.CrossRefPubMedPubMedCentral

13.

Bilodeau V, Saavedra-Mitjans M, Frenette AJ, Burry L, Albert M, Bernard F, et al. Safety of dexmedetomidine for the control of agitation in critically ill traumatic brain injury patients: a descriptive study. J Clin Pharm Ther. 2021;46(4):1020–6. https://doi.org/10.1111/jcpt.13389.CrossRefPubMed

14.

Tang Q, Wu X, Weng W, Li H, Feng J, Mao Q, et al. The preventive effect of dexmedetomidine on paroxysmal sympathetic hyperactivity in severe traumatic brain injury patients who have undergone surgery: a retrospective study. PeerJ. 2017;5: e2986. https://doi.org/10.7717/peerj.2986.CrossRefPubMedPubMedCentral

15.

Reade MC, Eastwood GM, Bellomo R, Bailey M, Bersten A, Cheung B, et al. Effect of dexmedetomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomized clinical trial. JAMA. 2016;315(14):1460–8. https://doi.org/10.1001/jama.2016.2707.CrossRefPubMed

16.

Stocchetti N, Zanier ER. Chronic impact of traumatic brain injury on outcome and quality of life: a narrative review. Crit Care (London, England). 2016;20(1):148. https://doi.org/10.1186/s13054-016-1318-1.CrossRef

17.

Poulsen I, Langhorn L, Egerod I, Aadal L. Sleep and agitation during subacute traumatic brain injury rehabilitation: A scoping review. Aust Crit Care. 2021;34(1):76–82. https://doi.org/10.1016/j.aucc.2020.05.006.CrossRefPubMed

18.

Singh R, Venkateshwara G, Nair KP, Khan M, Saad R. Agitation after traumatic brain injury and predictors of outcome. Brain Inj. 2014;28(3):336–40. https://doi.org/10.3109/02699052.2013.873142.CrossRefPubMed

19.

Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012;307(11):1151–60. https://doi.org/10.1001/jama.2012.304.CrossRefPubMed

20.

Pajoumand M, Kufera JA, Bonds BW, Devabhakthuni S, Boswell S, Hesselton K, et al. Dexmedetomidine as an adjunct for sedation in patients with traumatic brain injury. J Trauma Acute Care Surg. 2016;81(2):345–51. https://doi.org/10.1097/ta.0000000000001069.CrossRefPubMed

21.

Humble SS, Wilson LD, Leath TC, Marshall MD, Sun DZ, Pandharipande PP, et al. ICU sedation with dexmedetomidine after severe traumatic brain injury. Brain Inj. 2016;30(10):1266–70. https://doi.org/10.1080/02699052.2016.1187289.CrossRefPubMedPubMedCentral

22.

Hao J, Luo JS, Weng Q, He Y, Liu J, Yang MH, et al. Effects of dexmedetomidine on sedation and β-endorphin in traumatic brain injury: a comparative study with propofol. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013;25(6):373–6. https://doi.org/10.3760/cma.j.issn.2095-4352.2013.06.014.CrossRefPubMed

23.

Karaca O, Doğan G. The effects of dexmedetomidine in increased intestinal permeability after traumatic brain injury: an experimental study. TJTES. 2020;26(1):15–20. https://doi.org/10.14744/tjtes.2019.49768.CrossRefPubMed

24.

Wang X, Ji J, Fen L, Wang A. Effects of dexmedetomidine on cerebral blood flow in critically ill patients with or without traumatic brain injury: a prospective controlled trial. Brain Inj. 2013;27(13–14):1617–22. https://doi.org/10.3109/02699052.2013.831130.CrossRefPubMed

25.

Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol. 2012;62(1):118–33. https://doi.org/10.1016/s0034-7094(12)70110-1.CrossRefPubMed

26.

Weerink MAS, Struys M, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913. https://doi.org/10.1007/s40262-017-0507-7.CrossRefPubMedPubMedCentral

27.

Colin PJ, Hannivoort LN, Eleveld DJ, Reyntjens K, Absalom AR, Vereecke HEM, et al. Dexmedetomidine pharmacodynamics in healthy volunteers: 2. Haemodynamic profile. Br J Anaesthesia. 2017;119(2):211–20. https://doi.org/10.1093/bja/aex086.CrossRef

28.

Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753–62. https://doi.org/10.1001/jama.291.14.1753.CrossRefPubMed

29.

Steimer M, Kaiser S, Ulbrich F, Kalbhenn J, Bürkle H, Schallner N. Expression of HO1 and PER2 can predict the incidence of delirium in trauma patients with concomitant brain injury. Sci Rep. 2021;11(1):15388. https://doi.org/10.1038/s41598-021-94773-6.CrossRefPubMedPubMedCentral

30.

Maneewong J, Maneeton B, Maneeton N, Vaniyapong T, Traisathit P, Sricharoen N, et al. Delirium after a traumatic brain injury: predictors and symptom patterns. Neuropsychiatr Dis Treat. 2017;13:459–65. https://doi.org/10.2147/ndt.s128138.CrossRefPubMedPubMedCentral

31.

Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth. 2020;125(4):492–504. https://doi.org/10.1016/j.bja.2020.06.063.CrossRefPubMed

Title: The effect of dexmedetomidine on the postoperative recovery of patients with severe traumatic brain injury undergoing craniotomy treatment: a retrospective study
Authors: Zhu Deng
Yong Gu
Le Luo
Lin Deng
Yingwei Li
Wanyong Huang
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Central Nervous System Trauma
Dexamethasone
Craniotomy
Published in: European Journal of Medical Research / Issue 1/2024
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-024-01861-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of dexmedetomidine on the postoperative recovery of patients with severe traumatic brain injury undergoing craniotomy treatment: a retrospective study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Concentration strategies for spiked and naturally present biomarkers in non-invasively collected first-void urine

Effect of Buteyko breathing technique on clinical and functional parameters in adult patients with asthma: a randomized, controlled study

Effects of training flights of combat jet pilots on parameters of airway function, diffusing capacity and systemic oxidative stress, and their association with flight parameters

Torso hemorrhage: noncompressible? never say never

A dosiomics model for prediction of radiation-induced acute skin toxicity in breast cancer patients: machine learning-based study for a closed bore linac

Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis